title: Cost-effectiveness of early assisted discharge for COPD exacerbations in The Netherlands.
abstract: OBJECTIVE
  Hospital admissions for exacerbations of chronic obstructive pulmonary disease are the main cost drivers of the disease. An alternative is to treat suitable patients at home instead of in the hospital. This article reports on the cost-effectiveness and cost-utility of early assisted discharge in The Netherlands.
  
  
  METHODS
  In the multicenter randomized controlled Assessment of GOing Home under Early Assisted Discharge trial (n = 139), one group received 7 days of inpatient hospital treatment (HOSP) and one group was discharged after 3 days and treated at home by community nurses for 4 days. Health care resource use, productivity losses, and informal care were recorded in cost questionnaires. Microcosting was performed for inpatient day costs.
  
  
  RESULTS
  Seven days after admission, mean change from baseline Clinical Chronic Obstructive Pulmonary Disease Questionnaire score was better for HOSP, but not statistically significantly: 0.29 (95% confidence interval [CI]-0.04 to 0.61). The difference in the probability of having a clinically relevant improvement was significant in favor of HOSP: 19.0%-point (95% CI 0.5%-36.3%). After 3 months of follow-up, differences in effectiveness had almost disappeared. The difference in quality-adjusted life-years was 0.0054 (95% CI-0.021 to 0.0095). From a health care perspective, early assisted discharge was cost saving:-€244 (treatment phase, 95% CI-€315 to-€168) and-€168 (3 months, 95% CI-€1253 to €922). Societal perspective:-€65 (treatment phase, 95% CI-€152 to €25) and €908 (3 months, 95% CI-€553 to €2296). The savings per quality-adjusted life-year lost were €31,111 from a health care perspective. From a societal perspective, HOSP was dominant.
  
  
  CONCLUSIONS
  No clear evidence was found to conclude that either treatment was more effective or less costly.
authors.affiliation: Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands. goossens@bmg.eur.nl
authors.forename: Lucas M A
authors.initials: LM
authors.lastname: Goossens
authors.forename: Cecile M A
authors.initials: CM
authors.lastname: Utens
authors.forename: Frank W J M
authors.initials: FW
authors.lastname: Smeenk
authors.forename: Onno C P
authors.initials: OC
authors.lastname: van Schayck
authors.forename: Monique
authors.initials: M
authors.lastname: van Vliet
authors.forename: Walter
authors.initials: W
authors.lastname: van Litsenburg
authors.forename: Maria W
authors.initials: MW
authors.lastname: Braken
authors.forename: Maureen P M H
authors.initials: MP
authors.lastname: Rutten-van Mölken
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D004526:Efficiency; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006699:Home Care Services / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010351:Patient Discharge / Q000191:economics*; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics / Q000628:therapy*; D019057:Quality-Adjusted Life Years; D011795:Surveys and Questionnaires; D013997:Time Factors